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Bupropion brand
Wellbutrin, Zyban
Bupropion class
Norepinephrine and dopamine reuptake inhibitor
Bupropion use
Major depressive disorder, seasonal affective disorder, smoking cessation
Bupropion MOA
Inhibits neuronal reuptake of norepinephrine and dopamine
Bupropion dose
IR: 100 mg PO TID, 12h: 150 mg PO BID, 24h: 300 mg PO qAM
Bupropion contraindications
Seizures, bulimia, anorexia, MAO inhibitor use
Bupropion BBW
May cause suicidal thoughts in children and young adults
Escitalopram brand
Lexapro
Escitalopram class
SSRI
Escitalopram use
Major depressive disorder, generalized anxiety disorder
Escitalopram MOA
Selectively inhibits serotonin reuptake
Escitalopram dose
10 mg PO qD
Escitalopram contraindications
None
Escitalopram BBW
May cause suicidal thoughts in children and young adults
Fluoxetine brand
Prozac, Sarafem
Fluoxetine class
SSRI
Fluoxetine use
Major depressive disorder, OCD, panic disorder, premenstrual dysphoric disorder
Fluoxetine MOA
Selectively inhibits serotonin reuptake
Fluoxetine dose
20-80 mg PO qAM
Fluoxetine contraindications
None
Fluoxetine BBW
May cause suicidal thoughts in children and young adults
Sertraline brand
Zoloft
Sertraline class
SSRI
Sertraline use
Major depressive disorder, OCD, panic disorder
Sertraline MOA
Selectively inhibits serotonin reuptake
Sertraline dose
50-200 mg PO qD
Sertraline contraindications
None
Sertraline BBW
May cause suicidal thoughts in children and young adults
Venlafaxine brand
Effexor
Venlafaxine class
Serotonin-norepinephrine reuptake inhibitor
Venlafaxine use
Major depressive disorder, generalized anxiety, panic disorder
Venlafaxine MOA
Inhibits norepinephrine, serotonin, and dopamine reuptake
Venlafaxine dose
75-225 mg PO divided qD-TID
Venlafaxine contraindications
Avoid abrupt withdrawal
Venlafaxine BBW
May cause suicidal thoughts in children and young adults
Paroxetine brand
Paxil
Paroxetine class
SSRI
Paroxetine use
Major depressive disorder, OCD, panic disorder, social anxiety disorder, generalized anxiety disorder, PTSD
Paroxetine MOA
Selectively inhibits serotonin reuptake
Paroxetine dose
20-50 mg PO qAM
Paroxetine contraindications
None
Paroxetine BBW
May cause suicidal thoughts in children and young adults
Desvenlafaxine brand
Pristiq
Desvenlafaxine class
Serotonin norepinephrine reuptake inhibitor
Desvenlafaxine use
Major depressive disorder
Desvenlafaxine MOA
Inhibits norepinephrine, serotonin, and dopamine receptors
Desvenlafaxine dose
50 mg PO qD
Desvenlafaxine contraindications
Avoid abrupt withdrawal
Desvenlafaxine BBW
May cause suicidal thoughts in children and young adults
Duloxetine brand
Cymbalta
Duloxetine class
Serotonin norepinephrine reuptake inhibitor
Duloxetine use
Major depressive disorder, generalized anxiety disorder
Duloxetine MOA
Inhibits serotonin and norepinephrine reuptake
Duloxetine dose
60 mg PO qD
Duloxetine contraindications
Avoid abrupt withdrawal
Duloxetine BBW
May cause suicidal thoughts in children and young adults
Citalopram brand
Celexa
Citalopram class
SSRI
Citalopram use
Major depressive disorder
Citalopram MOA
Selectively inhibits serotonin reuptake
Citalopram dose
20-40 mg PO qD
Citalopram contraindications
Electrolyte abnormality, QT prolongation, arrhythmias, CHF
Citalopram BBW
May cause suicidal thoughts in children and young adults
Buspirone brand
BuSpar
Buspirone class
Non-benzodiazepine anxiolytic
Buspirone use
Anxiety
Buspirone MOA
Binds to serotonin and D2 receptors
Buspirone dose
20-30 mg PO qD divided BID or TID
Buspirone contraindications
MAO inhibitor use, renal impairment
Buspirone BBW
None
Mirtazapine brand
Remeron
Mirtazapine class
Tetracyclic antidepressant
Mirtazapine use
Major depressive disorder
Mirtazapine MOA
Antagonizes alpha-2 adrenergic and serotonin 5-HT2 receptors
Mirtazapine dose
15-45 mg PO qHS
Mirtazapine contraindications
MAO inhibitor use, avoid abrupt withdrawal
Mirtazapine BBW
May cause suicidal thoughts in children and young adults
What populations are more likely to experience depression?
Women, family history, peaks during adolescence
What are some psychological symptoms of depression?
Depressed mood, anhedonia, sadness, guilt, feelings of worthlessness
What are some physical signs of depression?
Insomnia, sleep disturbance, fatigue, weight changes, changes in appetite, pain, digestive problems, headaches, cramps
What other disease states can produce similar physical symptoms to depression?
Anemia, hypothyroidism, adrenal insufficiency, HIV, sleep apnea
Why are the elderly at risk for depression?
Loneliness, lack of social interaction
In general, what causes depression?
Brain structure dysfunction, imbalance of neurotransmitters
What brain regions are affected in depression?
Prefrontal cortex, hippocampus, amygdala, nucleus accumbens
What regions do we target with electrical stimulation and what effect does it have?
Prefrontal cortex and nucleus accumbens, improve symptoms in medication-resistant depressed patients
Which patients do we use electrode stimulation in?
High risk of commiting suicide, severely depressed, medication-resistant patients
What is dopamine’s physiological function?
Pleasure, mood, emotion, cognitive function, motivation, sex, appetite, aggression
What is norepinephrine’s physiological function?
Energy, mood, emotion, cognitive function, motivation, anxiety, aggression
What is serotonin’s physiological function?
Impulsivity, mood, emotion, cognitive function, sex, appetite, aggression
What is serotonin metabolized by?
MAO
What is the most effective way to increase neurotransmitter levels in the synapse?
Blocking the serotonin reuptake transporter (SERT)
What is the source of serotonergic neurons?
Dorsal raphe nucleus
How are dopamine and norepinephrine metabolized?
COMT, MAO
In general, what causes depression?
Decreased levels of monoamine neurotransmitters
How long does it take for patients to respond to SSRIs?
2-6 weeks
Why are SSRIs the most commonly prescribed antidepressant?
Fewer adverse effects, less dangerous in an overdose
Describe the MOA of SSRIs
SSRIs bind to SERT to increase serotonin levels which causes downregulation of presynaptic inhibitory 5HT1A receptors and stimulation of postsynaptic serotonin receptors resulting in production of BDNF, BDNF if neurotrophic and neuroprotective
What are some adverse effects of SSRIs?
Headache, dizziness, NV, sexual dysfunction, sleep disturbances, akathisia, suicide in children and adolescents, drug interactions
What are symptoms of serotonin withdrawal?
Malaise, muscle aches, chills, fever, sleep disturbances
What are some symptoms of serotonin syndrome?
akathisia, muscle twitches, hyperreflexia, myoclonus, sweating, seizures, coma
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